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1.
BMJ ; 365: l4389, 2019 06 27.
Article in English | MEDLINE | ID: mdl-31248882
2.
J Gastrointest Surg ; 21(12): 2056-2065, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28924962

ABSTRACT

AIM: The clinico-oncological significance of the distance of rectal cancer from the anal verge is unclear and not well reported. The aim of this study is to assess the influence of the rectal cancer distance from the anal verge on clinical management and long-term outcomes after curative resection in a specialised colorectal cancer unit. METHODS: Prospectively collected data on patients who underwent primary rectal cancer treatment at our unit between January 2005 and December 2010 were analysed. Low rectal cancer (LRC) was defined as tumour < 5 cm from the anal verge on MRI scan. Recurrent cancer, palliative resections, perforated tumours and those requiring total pelvic exenteration were excluded. RESULTS: Three hundred fifty-nine patients underwent surgery for rectal cancer (226 male/133 female). Of these, 149 (41.5%) patients had low rectal cancer (LRC). Compared to patients with mid/upper rectal cancer (M/URC), patients with low rectal cancers were significantly more likely to receive neo-adjuvant therapy (75.2 vs 38%; p < 0.001), to be associated with lower rate of restorative surgery (15.4 vs 79%; p < 0.001) and to have higher rates of pathological positive circumferential resection margin involvement (14.1 vs 7.1%; p = 0.047). There were however no significant difference in the rates of recurrent disease or survival among the two groups. CONCLUSION: Distance of rectal cancer from the anal verge does influence the use of neo-adjuvant treatment and ultimate R0 resection rate. It does not influence loco-regional or systemic recurrence rates.


Subject(s)
Anal Canal/diagnostic imaging , Rectal Neoplasms/diagnostic imaging , Rectum/diagnostic imaging , Adult , Aged , Aged, 80 and over , Anal Canal/pathology , Anal Canal/surgery , Digestive System Surgical Procedures , Female , Humans , Magnetic Resonance Imaging , Male , Margins of Excision , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Pelvic Exenteration/statistics & numerical data , Prognosis , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Rectum/pathology , Rectum/surgery , Retrospective Studies , Survival , Treatment Outcome , Young Adult
3.
Dis Colon Rectum ; 58(4): 393-400, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25751795

ABSTRACT

BACKGROUND: The prediction of lymph node metastasis by current histopathological methods is imprecise. OBJECTIVE: The aim of this study was to evaluate currently used and possible new high-risk features associated with lymph node metastasis to identify the markers of lymph node metastasis. DESIGN/PATIENT/SETTING: Two hundred seven pT1 cancers were identified through the Northern and Yorkshire Cancer Registry and Information Services database and digitally scanned. Phenotypic and quantitative features of the pT1 cancers were evaluated. Lymph node metastasis and high-risk feature status were obtained through pathology reports of resections, and high-risk phenotypic features were identified. RESULTS: Lymph node metastasis was noted in 19 patients (9.2%). pT1 cancers with lymph node metastasis had a significantly wider area of invasion (p = 0.001) and greater area of submucosal invasion (p < 0.001) compared with pT1 cancers without lymph node metastasis. Qualitative features such as grade of differentiation and vascular and lymphatic invasion were significant predictors of lymph node metastasis (p < 0.0001, p = 0.039, and p = 0.018). Modified receiver-operating characteristics curves generated cutoff values of 11.5 mm for the width of invasion and 35 mm(2) for the area of submucosal invasion. When tested separately with other qualitative factors on multivariate analysis, both width greater than 11.5 mm (OR, 12.12; 95% CI, 2.19-67.23; p = 0.004) and area of submucosal invasion greater than 35 mm(2) (OR, 22.44; 95% CI, 2.7-186.63; p = 0.004) was predictive of lymph node metastasis. LIMITATIONS: This is a retrospective study and is limited by its small sample size. CONCLUSION: This study has shown that the width and area of submucosal invasion are potential predictors of lymph node metastasis and superior to the depth of invasion. Together with the other qualitative phenotypic features, these quantitative factors could be used to decide the most appropriate treatment for pT1 cancers.


Subject(s)
Adenocarcinoma/secondary , Adenoma/pathology , Colorectal Neoplasms/pathology , Intestinal Mucosa/pathology , Aged , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Observer Variation , Prognosis , ROC Curve , Retrospective Studies , Risk Factors
5.
J Med Case Rep ; 3: 29, 2009 Jan 27.
Article in English | MEDLINE | ID: mdl-19173728

ABSTRACT

INTRODUCTION: Diverticulosis coli is the most common disease of the colon in Western countries. Giant colonic diverticulum, defined as a colonic diverticulum measuring 4 cm in size or larger, represents an unusual manifestation of this common clinical entity. CASE PRESENTATION: A 68-year-old Caucasian British woman with a history of intermittent lower abdominal mass, leg swelling and focal neurological symptoms underwent extensive non-diagnostic investigations over a significant period under a number of disciplines. The reason for a diagnosis being elusive in part related to the fact that the mass was never found on clinical and ultrasound examination. As a result, the patient's validity was questioned. Ultimately, this 'phantom-mass' was diagnosed as a giant colonic diverticulum causing intermittent compression of the iliac vein and obturator nerve. CONCLUSION: Intermittent compression of the iliac vein and the obturator nerve by a colonic diverticulum has not previously been reported. A giant colonic diverticulum presenting as an intermittent mass is very rare. This case also illustrates two factors. First, the patient is often right. Second, the optimal mode of investigation for any proven or described abdominal mass with referred symptoms is cross-sectional imaging, typically a computed tomography scan, irrespective whether the mass or symptoms are constant or intermittent.

6.
Dis Colon Rectum ; 51(7): 1100-6, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18470564

ABSTRACT

PURPOSE: We report the results of the cleft lift procedure in the management of nonacute pilonidal sinus disorders. METHODS: Seventy consecutive patients who underwent a cleft lift for nonacute pilonidal sinus were evaluated prospectively. Responses to a postal questionnaire were analyzed for long-term outcome. RESULTS: All patients who fulfilled the criteria for day-case were operated on as such. Sixty-six patients achieved complete wound healing within six weeks. Delayed wound healing occurred in three patients and nonhealing occurred in one. Fourteen patients had one or more complications: wound breakdown, superficial (n = 7) and deep (n = 1); wound infection (n = 5); wound seroma (n = 4); and early recurrence (n = 1). The median time off work and to return to normal activities was two and four weeks, respectively (range, 0.5-12). Forty-seven patients completed the questionnaire at a median follow-up of 24 months: five patients reported minimal tenderness in the sacral region; none reported recurrence of pilonidal symptoms; and all were satisfied. CONCLUSIONS: The cleft lift procedure is easy to perform as a day-case procedure. It is associated with high rates of primary healing, durable low recurrence rates, and early functional recovery. This technique may be the procedure of choice in the surgical management of nonacute pilonidal disorders.


Subject(s)
Digestive System Surgical Procedures/methods , Pilonidal Sinus/surgery , Surgical Flaps , Adolescent , Adult , Chronic Disease , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Surveys and Questionnaires , Time Factors , Treatment Outcome , Wound Healing
7.
Dis Colon Rectum ; 45(9): 1186-90; discussion 1190-1, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12352234

ABSTRACT

PURPOSE: Patients consider hemorrhoidectomy to be a painful operation. Attempts to reduce the length of inpatient stay have concentrated mainly on a reduction in postoperative pain. Metronidazole has been shown to reduce pain after open hemorrhoidectomy. The aim of this study was to evaluate the effect of metronidazole after closed hemorrhoidectomy. METHODS: Thirty-eight patients undergoing closed hemorrhoidectomy were randomly allocated to receive metronidazole 400 mg (n = 18) or placebo (n = 20) three times daily for seven postoperative days. All patients received a stool softener and analgesics perioperatively. Linear analog scales were used to assess expected pain, actual pain and patient satisfaction. Time to first bowel movement, return to normal activity, complications, and use of additional analgesics were recorded. RESULTS: Both groups of patients experienced less pain than expected. Patients in the metronidazole group required fewer additional analgesics postoperatively (6.3 vs. 26.3 percent), and satisfaction scores in the placebo group were higher at one week (0.5 vs. 2.5), although these differences were not statistically significant. There were no differences in pain actually experienced, time to first bowel movement, return to normal activity, or complications between the two groups. Satisfaction scores at six weeks for all patients were relatively high, with no significant difference between the groups. CONCLUSION: Closed hemorrhoidectomy results in high patient satisfaction and low pain scores. The use of postoperative metronidazole did not reduce postoperative pain.


Subject(s)
Analgesics/therapeutic use , Hemorrhoids/surgery , Metronidazole/therapeutic use , Pain, Postoperative/prevention & control , Double-Blind Method , Female , Humans , Male , Middle Aged , Pain Measurement , Patient Satisfaction , Statistics, Nonparametric
8.
Dis Colon Rectum ; 45(8): 1112-5, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12195200

ABSTRACT

A case of adenocarcinoma complicating the outflow tract remnant of a previously excised ileoanal pouch is described. The pouch had failed because of unsuspected Crohn's disease. This is the first reported case of malignancy complicating a pouch that had been constructed in a patient with Crohn's disease. More importantly, it demonstrates that carcinoma may develop in the outflow tract remnant left in situ after simple pouch excision. This case suggests that patients who require pouch excision may benefit from excision of the outflow tract.


Subject(s)
Adenocarcinoma/etiology , Anus Neoplasms/etiology , Crohn Disease/complications , Crohn Disease/surgery , Proctocolectomy, Restorative , Adult , Fatal Outcome , Humans , Male , Treatment Failure
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